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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Soaring Rates Of Hepatitis
C Pose Dilemma In US Prisons
By David Rohde

New York Times Service



NEW YORK - Prison officials say that nearly 10,000 inmates in New York and thousands of other prisoners across the region are infected with hepatitis C, an insidious liver infection that is difficult to treat, has no definite cure and, over many years, kills 5 percent of those who contract it. Prison and public health officials are wrestling with how to respond to the alarmingly high rates of infection, trying to figure out both how to contain its spread, and how and when to provide expensive treatment that, in most cases, does not work. Some states are treating hundreds of prisoners infected with hepatitis C, while others are treating none.

And beyond concerns about how to manage the problem inside the prisons - guards, for instance, fear being infected through contact with inmates' blood - public health officials worry that prisoners may spread hepatitis C through intravenous drug use when they are released.

A study to be submitted to Congress this fall estimates that 18 percent of inmates nationwide, or about 360,000 prisoners, are infected with the virus.

"There are still legitimate scientific questions about who the treatment will ultimately benefit," said Dr. Robert Greifinger, a senior fellow for the Centers for Disease Control and Prevention, who led the study for the Justice Department. "On the other hand, the infection rates are very, very high. I just don't think it's very clear yet how to manage the problem."

Dr. Greifinger based his study on projections from several state studies. Many states are only just beginning to survey inmates for the infection. In New York, a first-ever survey recently estimated that 14 percent of the state's 70,000 prisoners have hepatitis C. In Pennsylvania, 5,900 of the state's 36,500 prisoners are infected. In Connecticut, the rate is believed to be 15 percent of 17,500 inmates. New Jersey has not broadly tested for the disease.

The Northeast is hardly alone in grappling with this health problem. In California, officials estimate that 33 percent of the state's 161,000 prisoners have the disease. In Texas, nearly a third of the state's 157,000 prisoners are believed to be infected.

"It's simmering and brewing and if it boils over, the medical costs will be catastrophic," said Dr. Frederick Maue, chief of clinical services for the Pennsylvania Department of Corrections, which has aggressively treated inmates who have hepatitis C. "There will be liver transplants, multiple hospitalizations to treat liver failures, and increased numbers of deaths." Doctors say the problem is not that large numbers of prisoners are contracting hepatitis C while incarcerated; most were infected through intravenous drug use and shared needles years ago. It is that the infection's breadth and power are only now becoming clear. New screening tests developed in the early 1990s have found that far more people are infected than was ever expected, although many people who contract it suffer no ill effects.

But some people who were infected as long ago as the 1960s are dying today, underscoring the fact that the disease can prove fatal over the course of 20 to 30 years. Hepatitis C, which causes liver disease in 20 percent of its victims, kills 5 percent over two to three decades. Because of such statistics, doctors describe the infection as more of a potential medical time bomb than an immediate public health threat.

Roughly 2.7 million people are infected with the virus in the United States, nearly three times as many as have HIV, the virus that causes AIDS. A total of 8,000 people die from illnesses related to hepatitis C each year.The blood-borne virus is the leading cause of liver transplants in the United States. Aside from intravenous drug users, hundreds of thousands of other people are believed to have contracted the disease from blood transfusions before the early 1990s, when effective screening tests were developed.

The disease may be gradually spreading in prisons. Studies show that 3 percent to 21 percent of inmates say they engage in intravenous drug use while incarcerated; 44 percent of those who reported drug use said they had shared needles. The infection's death toll is rising.

The question of how best to treat the infection has provoked debate in medical circles. For some people, no treatment is required. But for people who show signs of developing liver disease, it is generally accepted that some form of treatment is advisable.

Expensive new drug treatments, costing from $10,000 to $20,000 per patient annually, show signs of curbing the infection. But they are effective in only 15 to 45 percent of cases.

Inmates in various states, including at least five in New York, are suing prison systems and claiming that they are being denied treatment. Last year, a federal judge in Kentucky ordered prison officials to treat an inmate for the disease at a cost of $25,000 a year.